Coping Tools for Trauma & Anxiety

When a flashback or intrusive memory takes hold, the aim is to remind your nervous system where and when you actually are.

Name five things you can see. Four things you can physically feel, the chair, your feet on the floor, fabric between your fingers. Three things you can hear. Two things you can smell. One thing you can taste.

It works because it forces attention outward through the senses, which competes directly with the internal replay. Say it out loud if you are alone. Do it twice if once is not enough.

Before you try this. There is no risk to this one. If a concussion makes counting or naming things effortful, simplify it: press your feet into the floor, hold something cold, and say where you are and what the date is. That is enough.

Panic speeds breathing up, which makes the physical symptoms worse, which increases the panic. Breaking that loop is the fastest route out.

Breathe in for four counts, hold for four, out for six, and pause for two. The long out-breath is the part that matters, because it activates the calming branch of your nervous system.

Do it for two minutes. It will feel like nothing is happening for the first thirty seconds. Keep going.

Before you try this. For a minority of people, paying close attention to their breathing increases anxiety rather than settling it, particularly after a collision that affected the chest or ribs. If that happens, stop and use grounding instead. Do not force the breath or hold it, and do not continue if you feel light-headed. If you have asthma, a lung condition, or you are pregnant, keep it gentle and mention it to your clinician.

Cold on the face and hands triggers a physiological reflex that slows the heart. It is crude, and it works when nothing cognitive will.

Hold your wrists under a cold tap, splash your face, or hold something from the freezer. Thirty seconds is usually enough to interrupt a rising panic.

Useful precisely because it requires no concentration, which is the first thing panic takes away.

Before you try this. Cold water briefly slows your heart rate, which is the point, but it means this one is not for everyone. Avoid it if you have a heart condition, an irregular heartbeat, uncontrolled high blood pressure, an eating disorder, or a circulation condition such as Raynaud’s, and avoid it if you have a facial injury from the collision. If you are unsure, ask your doctor or ask us first. The other techniques on this page work perfectly well without it.

Waking at three with your heart racing and the crash replaying is one of the most common experiences after a collision, and one of the loneliest.

Get out of bed. Lying there arguing with your own mind rarely works and teaches your brain that bed is where distress happens. Go to another room, keep the lights low, and do something undemanding until you feel sleepy.

Do not check the time repeatedly, and do not do anything on a phone screen that requires you to think. If your mind is racing with tasks, write them down so you can stop rehearsing them.

If this is happening most nights, tell us. Sleep can be measured objectively, and broken sleep drives pain, mood and concentration more than most people realize.

Our sleep guide →

Irritability after a collision is extremely common and rarely mentioned, because people are ashamed of it. A nervous system stuck on alert has a very short fuse.

Leave the room before you say the thing. Physical movement helps discharge it: walk, climb stairs, push against a wall. Anger is a physical state as much as an emotional one.

Tell the people around you that this is happening and that it is not about them. That single conversation prevents an enormous amount of damage.

Do less, deliberately. Pick one thing that matters and do only that. Depression and pain both respond badly to an ambitious list you then fail to complete.

Get dressed and get outside for ten minutes, even without wanting to. Activity reliably comes before motivation rather than after it. If a target helps, ask us about The Outside 1,000, our app that challenges and supports you to spend a thousand hours outside over a year. That works out at roughly two and three quarter hours a day, and the tracker counts every minute, so a ten-minute walk still moves the total.

Eat something. Low blood sugar mimics anxiety almost exactly, and appetite is often the first thing to go.

After a collision the part of the brain that detects threat becomes over-tuned. It is not damaged and it is not weakness: it is doing exactly what it is designed to do, having learned that the world is more dangerous than it previously believed.

The consequence is that ordinary things now trigger a full physiological alarm. Brake lights. A car door. Someone raising their voice. The response is automatic and arrives before any conscious thought, which is why telling yourself to calm down does not work.

The techniques on this page work by giving that system evidence of safety through the body rather than through argument. That is the whole principle behind grounding, paced breathing and cold water.

Your heart rate rises slightly as you breathe in and falls as you breathe out. That is normal, and it is the mechanism paced breathing exploits. Making the out-breath longer than the in-breath activates the part of your nervous system responsible for recovery, and your heart rate and blood pressure follow.

This is not a relaxation technique in the vague sense. It is a measurable physiological change, and it is the same principle behind the biofeedback we use in clinic, where you watch your own heart rate respond on a screen while you practise.

Four seconds in and six or eight out is the usual starting point. If counting makes you more anxious, simply make the out-breath longer than the in-breath without counting at all.

Avoiding something frightening brings immediate relief, and that relief teaches your brain that avoiding worked. The next time, the urge to avoid is stronger. This is why driving anxiety typically expands rather than fades: first the highway, then unfamiliar routes, then any drive at all.

Recovery runs the other way, through graded, repeated exposure that is deliberately small enough to be manageable. Not forcing yourself onto a motorway, but sitting in a parked car until it becomes dull, then once around the block, then the same route again until it is boring.

Boredom is the goal. It is the clearest sign your nervous system has updated its assessment.

Poor sleep lowers your threshold for pain, shortens your temper, worsens concentration, and makes low mood considerably harder to shift. It is rarely just one symptom among several. It is usually the one making the others worse.

That is why we measure it objectively rather than relying on how you think you slept. The Quantitative Sleep Assessment© records what is actually happening across several nights in your own bed, because self-report and measured sleep often differ substantially.

Start as a passenger, on a familiar route, in daylight, with someone you trust driving. Sit in the front rather than the back if you can manage it. Repeat the same journey until it stops producing a reaction.

Then drive that route yourself. Then a slightly longer one. Do not jump to the highway because you feel you ought to be able to manage it.

If this stalls, it is treatable and we measure it objectively with our Mental Health Driving Anxiety Assessment©, then treat it with graded exposure using virtual reality, which lets you practise safely before you are back on a real road. See our guide to returning to driving.

A flashback is a memory being replayed as though it is happening now, because it was stored without the usual time stamp. Grounding works by giving your brain present-tense sensory evidence that contradicts it.

Name five things you can see, out loud if you are able. Press your feet into the floor. Hold something cold. Say the date and where you are. It feels absurd and it works.

Do not try to push the memory away, which tends to strengthen it. Let it pass while keeping one foot in the present.

Anger after trauma is usually the alarm system misfiring rather than genuine anger at the person in front of you, and it lands hardest on family because they are who you are with.

Name it early, before it builds: tell them you are wound up and need ten minutes. Move your body if you can. Come back and finish the conversation rather than leaving it unresolved.

If this is straining your relationships, couples and family counselling is available and may be funded under the claim. See family and caregiver support.

Extremely common and rarely mentioned, particularly among people who were the driver, who were previously the one looking after everyone else, or who cannot work and feel they are failing their family.

These feelings respond well to treatment and very poorly to being kept private. They are also the feelings most likely to stop someone asking for help, which is precisely why they are worth raising at a first appointment.

Pain that outlasts the tissue damage is real. It is not imagined, and a normal scan does not mean nothing is wrong. The nervous system can continue producing pain after the original injury has settled.

Pacing helps more than pushing through. So does treating the sleep and the mood, because all three feed each other. Our chronic pain assessment looks at function rather than asking you to rate your pain out of ten.

Frequently assumed to be brain injury when it is just as often caused by poor sleep, pain, medication, or the sheer cognitive load of anxiety. Those causes need quite different treatment, which is why guessing is unhelpful.

In the meantime, write things down rather than relying on memory, do demanding tasks at your best time of day, and do one thing at a time. If it persists, neuropsychological assessment establishes what is actually happening.